How to Lead Through Public Healths Controversial Waters

Dora Anne Mills, MD, MPH Director, Maine CDC/DHHS

November, 2008

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Maine CDC

We all have personal opinions, religion and politics, but the Surgeon General communicates based on the best available science.
- Dr. David Satcher, July 2007

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Some Tools to Address Public Health Science

Leadership styles
Social marketing strategies Understand common strategies we are countering

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All Tools Take Leadership

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Leadership That Gets Results

Daniel Goleman Harvard Business Review August, 2000

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Studied over 3,000 executives

6 leadership styles Exemplary leaders use 4-6 styles Choosing the most appropriate for the individual situation

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6 Leadership Styles
Authoritative mobilize people toward a vision Affiliative create emotional bonds and harmony Coaching develop people for the future Democratic build consensus through participation

Pacesetting expect excellence and self-direction

Coercive demand immediate compliance

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Tools to Promote Science

Education using scientific information Policies/laws Social Marketing

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Social Marketing
A tool when science is not enough

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Social Marketing
Why are people not taking action? Reduces barriers to action Promotes benefits In the eyes of the audience

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Social Marketing-Related Questions to Ask When Faced with Dilemmas:

Who needs to take action? What action?

What are the benefits of action?

What are the barriers to taking action? (including competitive promotion)

How to best reach audience when and where?

What methods to reach audience? Who - what spokespeople are the most effective?

What partners can help?

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Vaccines and Thimerosal

Dilemma: Legislative hearing to ban thimerosal-containing vaccines

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Health Officials Discuss Link Between Autism, Flu Vaccine 9/21/2005

Thimerosal isn't safe April 17, 2006

Is there a link between autism and vaccination?

Legislatures considering bills that would ban thimerosal

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Vaccines and Thimerosal

Strategies used by proponents

Pseudo-science e.g. loose associations

Policies
Web and other networking

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Vaccines and Thimerosal

Who needs to take action?

Primary: Legislators Secondary: Parents

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Vaccines and Thimerosal

What action?
Vote against a ban on thimerosal in vaccines

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Vaccines and Thimerosal

Benefits?
Vaccines will be more available especially for emergency situations such as pandemic, snake bites, travel

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Vaccines and Thimerosal

Barriers?
A room full of passionate mothers and autistic kids and a desire to do something about this tragic situation

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Vaccines and Thimerosal

How?
Hearing at the Legislature

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Vaccines and Thimerosal

Strategies?
Acknowledge frustration and emotion in the room Shift passion to common ground no tracking data for autism

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Vaccines and Thimerosal

By Whom?
Maine

Autism Society of Maine

Medical/Pediatric Associations

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Vaccines and Thimerosal

Most effective leadership styles

Affiliative Democratic Authoritative

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Fluoride
Dilemma: Bar Harbor votes to ban community water fluoridation. Bangor City Council schedules hearing on the subject.

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Town says no to fluoride Bar Harbor Times March 7, 2007

Unreasoned Fears Of Flouride Down East Magazine June, 2007

Giving Fluoridation Teeth March 19, 2007

Mount Desert Fluoride Vote Sparks Debate Island Institute September 24, 2007

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Fluoride

Strategies used by proponents

Pseudo-science

Policies
Web and other networking

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Fluoride

Who needs to take action?

Primary: Bangor City Council Primary: All municipal policymakers across Maine Secondary: General public

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Vaccines and Thimerosal

What action?
Vote against a ban on fluoride

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Fluoride

Benefits?
Teeth and overall health are stronger

Health care costs reduced

Fewer people with poor dentition

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Fluoride

Barriers?
Fear misinformation sounds so credible

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Fluoride

How?
Immediate

Statewide

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Fluoride

Strategies?
Press

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Fluoride

By Whom?
Maine and every other major health organization

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Fluoride

Most effective leadership styles

Authoritative

Democratic

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Abstinence Only Education

Dilemma: Want to stand for science and reject Federal A-O funds after accepting the funds

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Maine Rejects Federal Abstinence-only Sex-ed Funds September 23, 2005

Maine Declines Federal Funds for Abstinence-Only Sex Education Programs, Says New Guidelines Prohibit 'Safe-Sex' Curriculum September 21, 2005

US state rejects federal funding for abstinence only sex education October 1, 2005

Maine right to abstain from funds with a catch September 21, 2005
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Abstinence Only Education

Strategies used by proponents

Pseudo-science

Policies
Web and other networking, including religious organizations

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Abstinence Only Education

Who needs to take action?

Need policymakers to support Governors decision to reject Federal A-O funds

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Abstinence Only Education

What action?
Need them not to take any action

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Abstinence Only Education

Benefits?
A-O Funds do not work and can do our youth harm:
Forces a gag order on full information (youth with full information, that includes abstinence, are more likely to make the healthiest choices for their situation) Sends harmful messages to some kids (gay students, etc.)
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Abstinence Only Education

Barriers?
Monetary (turning back Federal funds)

Angers those who agree with A-O approach

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Abstinence Only Education

How?
Press

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Abstinence Only Education

Strategies?
Press conference with many health and education partners Many collateral opinion pieces

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Abstinence Only Education

By Whom?
Maine and health and education leaders Family Planning, many health and education partners, faith-based organizations, etc.

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Abstinence Only Education

Most effective leadership styles

Authoritative

Democratic

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Lyme Disease
Dilemma: Lyme Disease advocates want insurance coverage for non-standard treatments and legitimacy (links from our websites, etc.)

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Living With Lyme Disease May 17, 2007

PHOTO GALLERY

'Legend of North Country' Bill Chinnock dies at 59 March 9, 2007

Lost to Lyme March 18, 2007

Chinnocks Lyme disease activism hailed By The Associated Press March 19, 2007
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Lyme Disease

Strategies used by proponents

Pseudo-science

Policies
Web and other networking

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Lyme Disease

Who needs to take action?

Primary: Legislators Secondary: General Public

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Lyme Disease

What action?
Reject current legislation to require insurance

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Lyme Disease

Benefits?
Reduce growth of antibiotic resistance that can harm all of us Reduce harm to individuals of antibiotic overuse Reduce costs of insurance

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Lyme Disease

Barriers?
Perception that people need chronic intravenous antibiotics A few physicians are supportive of this non-standard approach

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Lyme Disease

How?
Legislative hearings

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Lyme Disease

Strategies?
Legislative hearing

Letters and phone calls to legislators

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Lyme Disease

By Whom?
Maine Infectious disease physicians in Maine

Medical Associations (MMA, MOA)

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Lyme Disease

Most effective leadership styles

Authoritative

Affiliative

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